Prognostic Factors of Oligometastasis After Stereotactic Body Radiotherapy: The Real-World Utility of the European Society for Radiotherapy and Oncology/European Organisation for Research and Treatment of Cancer Classification

Abstract

Aim: The efficacy of local therapy for oligometastatic disease (OMD) remains unclear. This study aimed to evaluate the prognostic utility of the classification system for OMD and explore which groups may benefit from stereotactic body radiation therapy (SBRT).

Methods: This single-center retrospective study included 45 patients (52 sites) with solid tumors and 1-3 extracranial oligometastases who underwent SBRT for all metastases at our institution between January 2018 and December 2021. OMD states were classified based on the European Society for Radiotherapy and Oncology (ESTRO) and the European Organisation for Research and Treatment of Cancer (EORTC) classification system. Local control (LC), overall survival (OS), and progression-free survival (PFS) for each group were analyzed using the Kaplan-Meier method. Acute and late adverse events (AEs) were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.

Results: The median follow-up period was 14 months (range: 0-48 months). The numbers of patients in the de novo (first diagnosis of OMD), repeat (previous history of OMD), and induced (previous history of polymetastatic disease) OMD groups were 15, 17, and 13, respectively. The LC rates at one year for the entire, de novo, repeat, and induced cohorts were 87.2%, 87.5%, 90.2%, and 83.9%, respectively (p=0.80). The one-year PFS rates for each group were 35.0%, 56.7%, and 29.9%, respectively (p=0.58). The one-year OS rates for each group were 80.0%, 86.2%, and 80.8%, respectively (p=0.50). Grade 2 or 3 AEs occurred in five patients (10.4%). No grade 4 or 5 AEs were observed.

Conclusions: SBRT is safe and highly effective for local control. Patients with repeat OMD demonstrated a trend of longer PFS, suggesting that this subgroup may benefit from local therapy at metastatic sites.

Keywords: adverse effects; cancer prognosis; oligometastases; progression-free survival; stereotactic ablative body radiotherapy.

Figure 1. The classification of OMD and the transition of its state by ESTRO/EORTC

OMD, oligometastatic disease; ESTRO/EORTC, European Society for Radiotherapy and Oncology/European Organisation for Research and Treatment of Cancer

Figure 2. The progression-free survival (PFS) rate of the subgroups per the ESTRO/EORTC classification (A) and de novo OMD cohort stratified by chronicity (B)

One patient with metachronous OMD developed distant metastasis during the course of the treatment, resulting in the survival curve starting below 1.0 ESTRO/EORTC, European Society for Radiotherapy and Oncology/European Organisation for Research and Treatment of Cancer; OMD, oligometastatic disease